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When Is Stomach Pain an Emergency?

Posted on Sep 14, 2020

Belly pain is a common problem in children. On this week’s On Call for All Kids, Joe Perno, M.D., vice president of medical affairs and the vice chairman of the Department of Medicine at Johns Hopkins All Children’s Hospital, explains how parents will know when it is serious.

There are certain warning signs with should prompt parents to bring their children to the Emergency Center. Anytime abdominal pain is constant and severe they should be seen. One of the most common abdominal pain emergencies is appendicitis. This typically starts with pain around the belly button and gradually moves to the lower right side. Typically the pain is constant and made worse by movement or touching that area. Often the pain is followed by nausea, vomiting, fever or loss of appetite. Anytime a child has these symptoms, he or she should see a doctor right away.

In contrast, when you have an upset stomach, usually you are vomiting first, followed by abdominal pain. Often the pain is everywhere or in the upper part of the stomach. Although not necessarily an emergency, vomiting that doesn’t stop usually will require a visit to the Emergency Center to help prevent dehydration and evaluate for other causes of vomiting.

Are there other abdominal pain emergencies parents should watch for?

Another abdominal pain emergency occurs typically in children less than 2 years of age. It is called intussusceptions, and it involves the intestines telescoping inside each other. The children usually have what appears to be severe abdominal pain intermittently interspersed with sleepiness. Many times the children will pull their legs to their chests when they are in pain. Sometimes there will be blood in the stool. If parents suspect this, they should bring the child to the Emergency Center.

What is the most common cause of abdominal pain in children?

The most common cause of abdominal pain in children is constipation. Due to poor diet, inadequate fluid intake and a busy lifestyle, many children end up constipated. Most kids do not eat enough vegetables or drink enough water. Often children will not poop at school or will ignore the urge if they are too “busy” playing or watching TV. Constipation will often cause severe intermittent abdominal pain. Sometimes the children are doubled over in pain. Unlike appendicitis, the children usually feel better with movement and the pain will resolve; sometimes for hours. Parents should review with the child, their bowel habits and if they think they are constipated, and encourage fiber, fluids and even an over the counter laxative such as Miralax. Enemas are also a possible solution for parents.
If the pain is unrelenting, severe or the family is not sure, they should visit the Emergency Center. 

What are some of the other causes of abdominal pain?

There are many things that can cause abdominal pain. In girls, ovarian problems such as ovarian cysts or twisted ovaries can cause pain. Typically this causes pain in the lower portion of the abdomen and can mimic appendicitis. Urinary tract infections can cause pain in boys and girls. Also, testicular problems and hernias can present with abdominal pain.

Overall, any pain that is not relenting, is severe or the source cannot easily be identified by the parents should be seen by their doctor or in an emergency department.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital experts. Visit  HopkinsAllChildrens.org/Stories each Monday for the latest report. Check out more advice from Joe Perno, M.D. 


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